Profiteering from the opioid crisis

Almost like magic, the drug naloxone can bring victims of opioid overdoses back from the brink of death. With more than 115 people dying each day from opioid overdoses across the country, the drug could save thousands of lives each year.

Except for one problem.

The prices of naloxone set by drug makers have skyrocketed, putting it beyond the reach of some police, first responders, community groups, and families and friends of overdose victims.

Though the drug has been around in generic form for more than 30 years — which ought to make it cheap — the price for one injectable form more than tripled since 2012. Another, according to a study set to be published in the journal Addictive Behaviors, rose 244% since 2006.

Naloxone is not a cure for addiction, but much like a defibrillator for heart attack victims, it revives people so they can live long enough to get treatment.

While price gouging in the drug industry has spurred major scandals, until recently naloxone’s price hikes weren’t getting much attention. That's changing.

Senators have demanded answers from several manufacturers. Researchers in publications such as the New England Journal of Medicine have dissected the price hikes. And President Trump's commission on combating the opioid crisis reported last year that lack of affordability was preventing state and local governments and community groups "from stocking naloxone at the levels necessary to rescue more people."

In other words, people are dying unnecessarily.

Many of those who see the carnage on the streets were disappointed last week when Trump announced a plan to lower prescription drug prices but failed to even mention naloxone.

Consumer advocacy organization Public Citizen and Baltimore's health commissioner, Leana Wen, wrote to the White House asking the administration to use existing laws to rein in the price of naloxone, adding that high prices are forcing her to "ration treatment, constantly stretching supplies that could be distributed in a week across months."

West Virginia Health Commissioner Rahul Gupta says the state's volunteer fire departments are particularly stressed. He cites as an example the astronomical price of an auto-injector called Evzio, which drug maker Kaléo says came on the market in 2014 at $575 for a pack of two and is now $4,100.

Even a generic injectable form of naloxone made by Hospira, purchased by drug giant Pfizer in 2015, more than tripled, from about $3.75 per dose in 2012 to $11.87 per dose now. Only Narcan, a naloxone nasal spray, has not increased in price since its 2016 introduction at $150 per two-pack. But even Narcan's discount price of $75 is too steep for many governments.

It's not as though these companies are risking billions of dollars to invent a new drug. They're simply developing different delivery mechanisms for an existing, inexpensive one.

Manufacturers insist that "list prices" are meaningless because of all the discounts they offer. Pfizer adds that it has not raised the price of naloxone since acquiring Hospira. But the actual prices paid by consumers for prescription drugs are virtually indecipherable because of all those discounts, coupons and "patient access programs."

Further confusing the situation is a gaggle of terms such as the "wholesale access price" (WAC) and the "average wholesale price" (AWP), which one expert jokingly called the "ain't what's paid" price. Complexity makes it easier to hide unscrupulous behavior.

Two things are clear: Prices of most naloxone products have increased, sometimes drastically, as more people are dying from overdoses of prescription painkillers and other opioids. And someone is picking up the tab, including taxpayers who foot the bills for government purchases.

Drug makers helped cause the opioid epidemic by misrepresenting the risks of addiction. It's unconscionable that other drug makers are profiteering from the crisis when so many lives are at stake.